paediatric malnutritionn Flashcards
how is an underweight child defined ?
weight for age < -2 SD
how is a stunting child defined ?
height for age < -2 SD
how is wasting inn a child defined ?
weight for height < -2SD
how is an overweight child defined ?
weight for height > +2 SD
what is stunting ?
long term nutritional deprivation and results in :
delayed mental development
poor school performance
reduced intellectual capacity
what are the different types of protein energy malnutrition ?
severe PEM :
Marasmus
kwashiorkor
how can acute severe malnutrition be diagnosed ?
the presence of one or more of :
mid-upper arm circumference < 115 mm
severe wasting ( < -3SD)
oedema of both feet
what are the features of marasmus ?
caused by deprivation of energy + protein
weight loss of more than 20%
maintain their hunger despite appearing irritable
what are the physical findings found upon examination of a marasmus patient ?
loss os subcutaneous fat wrinkled skin and bone prominence limbs appear as skin and bone severe muscle wasting severe growth retardation
when does marasmus mainly occur ?
in infants under one year of age
when does kwashiorkor mainly occur ?
at the time of weaning
what is the pathophysiology behind kwashiorkor ?
previously malnourished patient when exposed to the catabolic stress of infection
what are the clinical manifestations of kwashiorkor ?
generalized oedema skin rash - hyperkeratosis and desquamation distended abdomen and enlarged liver angular stomatitis flag sign
why may the weight of a kwashiorkor patient not be severely reduced ?
because of the severe oedema
what are the lab findings in kwashiorkor ?
everything is reduced except sodium
has dilutional hyponatraemia
what are the two phases included in the management of PEM ?
stabilisation and rehabilitation
when should iron be introduced in the management of PEM ?
in the rehabilitation phase only
what is the prophylactic dose of iron to avoid iron deficiency anemia ?
2mg/kg/day
what is the treatment dose of iron in iron deficiency anemia ?
6mg/kg/day for 3 months
what is the most common cause of microcytic hypochromic anemia ?
iron deficiency anemia
what additional supplementations can be added to children suffering from iron deficiency anemia and refuse to eat haem sources of iron ?
include vitamin c to increase absorption of iron
what is pica ?
eating things that are not considered food , and may be associated with iron deficiency anemia
what is the clinical presentation of vitamin D deficiency ?
bony deformity
symptoms of hypocalcemia : seizures, tetany, apnea, stridor
what is the difference between rickets and osteomalacia ?
rickets :failure in mineralization of the growing bone
osteomalacia : failure of mature bone to mineralize
what are the organs involved with calcium absorption ?
the intestines and the kidneys
what are the different types of rickets ?
vitamin D deficiency - Renal disease
calcium deficiency - chronic liver disease
what is the most likely cause of rickets that is due to both vit d and calcium deficiency ?
malabsorption i.e cystic fibrosis
what are the physical features associated with rickets ?
delayed closure of sutures bowing of the legs frontal bossing dental hypoplasia pigeon chest harrisons sulcus
how is a diagnosis of rickets made and how is it confirmed ?
mainly clinical but confirmed by testing : ALP phosphatase vit D serum levels serum calcium long bone X-ray
what is the prophylactic dose of vitamin d ?
400-600 IU/day
what is the treatment dose of vit d ?
less than a month : 1000 units
from 1-6 months : 3000 units
above 6 months: 6000 units
all for the duration of one month
what is the dose for calcium supplementation ?
500 mg/day
what is the commonest cause of blindness in children of developing countries ?
vitamin A deficiency
what are the clinical signs of vitamin A deficiency ?
xeropthalmia night blindness bitot spots dry skin and hair broken fingernails
what is the dose of supplementation of vitamin A at 12 months ?
with MMR vaccine 100.000 IU
what is the dose of vitamin A given at 18 months ?
with the OPV, DPT and MMR
a dose of 200.000 IU
what is the treatment dose for vitamin A deficiency ? under 3 years 4-8 years 9-13 years 14-18 years all adults
under 3 years - 600 mcg 4-8 years - 900 mcg 9-13 years - 1700 mcg 14-18 years - 2800 mcg all adults - 3000 mcg
